Modelling the effects of decentralisation on the Ugandan Health system: SPEED convenes an Expert group meeting in Kampala- Uganda


March 2019, SPEED– through her Post-Doctoral Fellow Dr Christine Kirunga- organised an expert group meeting to discuss the effects of decentralisation on the Uganda Health system. The meeting attracted key experts from the Ministry of Health (MoH), academia including Makerere University, Uganda Martyrs University and Cavendish University, the Medical Bureaus, District Local governments, Regional Referral Hospitals, international and local NGOs and Civil Society Organizations with expertise in health systems both at technical and implementation levels.

Dr. Christine K Tashoba presenting the draft proposal at Piato restaurant.

In his welcome remarks, Prof Freddie Ssengooba – Director SPEED project informed participants that the process of developing a study protocol to help improve the way decentralisation contribute to health system was underway.  He noted that it’s feasible to see how decentralisation has contributed to health ultimately contributing to the broad goal of achieving UHC.  “This meeting is meant to bring experts from different implementation areas to see how health services can be improved reflecting on how decentralisation system has worked. Therefore at the end of the engagement, a product that can be shared with the government, donors, and implementers will be produced to guide on how to improve the health of Ugandans.” Prof. Freddie noted.

The main objective of the meeting was to work with experts to get views around decentralisation and to seek their experience to inform the study proposal. The discussion was guided with two key questions;

  1. a) has decentralisation been good to the Ugandan Health system?
  2. b) Why do you think so? What are your reasons for this answer?
  3. Where (what) are the key challenges of decentralisation in Uganda (health system)-design, implementation or others?
  4. a) Where are the key challenges and facilitating factors for decentralisation?

Participants noted that decentralisation increased and empowered local structures to own the services provided as well as improving community participation in the services provided at various facilities. However, it was noted that this system had a number of challenges. These included, Heavy control of financial decisions from the central government affects district’s independent decisions, Poor district leadership, frustration in district health leadership affects services delivery, Restrictive autonomy for district planning and Patronage, intrigue and personalizing of issues characterize most districts.